吲哚菁绿在腹腔镜胆囊切除术中理想的 胆道显影：术前注射时机临床分析

The Ideal Bile Duct Visualization of Indocyanine Green in Laparoscopic Cholecystectomy: A Clinical Analysis of the Timing of Preoperative Injection

摘要: 目的：探究腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)中，术前注射吲哚菁绿(indocyanine green, ICG)荧光造影剂在胆管可视化操作方面的可行性，并分析其达到理想胆道显影的术前最佳时间。方法：收集2024年4月至2025年5月60例在保定市第二医院接受荧光LC的患者临床资料，进行前瞻性分析。结果：三组的一般资料、术中出血量、术中胆管损伤率、术后胆漏发生率、术后住院时间均无统计学意义(均P > 0.05)；在荧光强度差值方面，三组间存在显著差异(P < 0.05)，其中4~8 h组均高于其余两组(P < 0.05)；在胆管识别效果方面，三组差异存在统计学意义(P < 0.05)，4~8 h组胆管识别效果均较其他两组存在统计学意义(P < 0.05)；0~4 h组与8~12 h组胆管识别效果差异无统计学意义(P > 0.05)；在术中解剖胆囊三角时间方面，4~8 h组均低于其余两组(P < 0.05)。结论：运用吲哚菁绿荧光显影技术在腹腔镜胆囊切除术中，行胆管可视化操作是便捷、可行的。选择在LC术前4~8 h进行外周静脉注射ICG 2.5 mg可以在术中观察到理想的肝外胆管。

Abstract: Objective: To investigate the feasibility of preoperative injection of indocyanine green (ICG) fluorescent contrast agent in laparoscopic cholecystectomy (LC) for bile duct visualization and to analyze the optimal preoperative timing for achieving ideal bile duct visualization. Methods: Clinical data from 60 patients who underwent fluorescence LC at The No. 2 Hospital of Baoding between April 2024 and May 2025 were collected and analyzed prospectively. Results: There were no statistically significant differences between the three groups in terms of general data, intraoperative blood loss, intraoperative bile duct injury rate, postoperative bile leakage incidence, and postoperative hospital stay (all P > 0.05). There were significant differences in fluorescence intensity differences among the three groups (P < 0.05), with the 4~8 hours preoperative group being higher than the other two groups (P < 0.05). In terms of bile duct identification efficacy, there were statistically significant differences among the three groups (P < 0.05). The bile duct identification efficacy of the 4~8 h group was statistically significantly better than that of the other two groups (P < 0.05). There was no statistically significant difference in bile duct identification efficacy between the 0~4 h group and the 8~12 h group (P > 0.05). In terms of the time required for intraoperative dissection of the gallbladder triangle, the preoperative 4~8 groups were lower than the other two groups (P < 0.05). Conclusions: The use of indocyanine green (ICG) fluorescence imaging technology for bile duct visualization during laparoscopic cholecystectomy is convenient and feasible. Administering 2.5 mg of ICG via peripheral intravenous injection 4~8 hours prior to laparoscopic cholecystectomy (LC) enables optimal visualization of the extrahepatic bile ducts during surgery.